The THINC-Integrated Tool (THINC-it) Screening Assessment for Cognitive Dysfunction: Validation in Patients With Major Depressive Disorder
Abstract
OBJECTIVE: To validate the THINC-integrated tool (THINC-it)-a freely available, patient-administered, computerized screening tool integrating subjective and objective measures of cognitive function in adults with major depressive disorder (MDD). METHODS: Subjects aged 18 to 65 years (n = 100) with recurrent MDD experiencing a major depressive episode of at least moderate severity were evaluated and compared to age-, sex-, and education-matched healthy controls (n = 100). Between January and June 2016, subjects completed the THINC-it, which includes variants of the Choice Reaction Time Identification Task (IDN), One-Back Test, Digit Symbol Substitution Test, Trail Making Test-Part B, and the Perceived Deficits Questionnaire for Depression-5-item (PDQ-5-D). RESULTS: The THINC-it required approximately 10 to 15 minutes for administration and was capable of detecting cognitive deficits in adults with MDD. A total of 44.4% of adults with MDD exhibited cognitive performance at ≥ 1.0 SD below that of healthy controls on standardized mean scores of the THINC-it. Concurrent validity of the overall tool, based on a calculated composite score, was acceptable (r = 0.539, P < .001). Concurrent validity of the component tests ranged from -0.083 (IDN) to 0.929 (PDQ-5-D). Qualitative survey results indicated that there was a high level of satisfaction and perceived value in administering the THINC-it regarding its impact on the appropriateness and quality of care being received. CONCLUSIONS: The THINC-it is a valid and sensitive tool for detecting cognitive dysfunction in adults with MDD that is free, easy to use, and rapidly administered. The THINC-it should be incorporated into the assessment and measurement of all patients with MDD, particularly among those with enduring functional impairment. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02508493.
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The THINC-it app has been validated to identify cognitive dysfunction within the context of depressive disorder.
“The app has been validated to identify cognitive dysfunction within the context of depressive disorder [28].”
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“…be recommended to apply more sensitive tools devoid of ceiling effects, for example the Screen for Cognitive Impairment for Psychiatry (SCIP) (Miskowiak et al., 2021; Miskowiak et al., 2017) and THINC-integrated tool (THINC-it) (McIntyre et al., 2020; McIntyre et al., 2017; McIntyre et al., 2013).”
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BackgroundResultCognition in depression: Can we THINC-it better?
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“THINC-integrated tool (THINC-it) (62) Patient • Computerized cognitive battery assessing both objective and subjective cognitive deficits in MDD • 10–15 min, digital administration of 5 subtests: DSST, CRT, TMT-B, PDQ-D-5, and one-back working memory tool”
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Self-citationDemyttenaere, K., Costa, T., Kavakbasi, E., Jiang, M., Scheltens, A., Dibué, M., Hall, B., Andrade, P., McAllister-Williams, H., Baune, B. T., et al. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.10.054 · Cited by 12 · see citing works
Self-citationZhou, H., Wang, M., Qi, S., Chen, Q., Lai, J., Wu, Z., Liu, R., Wang, L., Zhou, H., Zhang, S., et al. (2025) · Molecular Psychiatry · doi:10.1038/s41380-025-03292-7 · Cited by 13 · see citing works
“…(THINC-it) toassessthe changes in cognitivefunctioning, which includes variants of the Choice Reaction Time Identi fi cation Task (IDN), One-Back Test, Digit Symbol Substitution Test (DSST), Trail Making Test-Part B, and the Perceived De fi cits Questionnaire for Depression-5-item (PDQ-5-D) [26].”
Knight, M. J., Lyrtzis, E., Fourrier, C., Aboustate, N., Sampson, E., Hori, H., Cearns, M., Morgan, J., Toben, C. G., & Baune, B. T. (2021) · Psychiatry Research · doi:10.1016/j.psychres.2021.113906 · Cited by 10 · see citing works
Self-citationSzyszkowska, J., & Bala, A. (2023) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2023.05.351 · Cited by 11 · see citing works
Lu, Z., Wang, Y., & Xun, G. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.696903 · Cited by 8 · see citing works
Zhang, F., Liu, W., Zheng, Y., Liu, C., Hu, Y. G., Chen, H., Tang, X., Wei, Y., Zhang, T., Wang, J., et al. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.01.011 · Cited by 8 · see citing works
Ribeiro, N., Vigier, T., Han, J., Kwon, G. H., Choi, H., Bulteau, S., & Prié, Y. (2024) · Cyberpsychology Behavior and Social Networking · doi:10.1089/cyber.2023.0314 · Cited by 8 · see citing works
“19,20 Each test gives one global score of performance.”
Zhang, S., Yuan, M., He, D., Dang, W., & Zhang, W. (2024) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-023-01741-4 · Cited by 8 · see citing works
“Prior to the analysis, Spotter and Trails test scores were transformed into standard Z scores and multiplied by -1 to ensure a higher score indicated better cognitive function, following guidelines by McIntyre et al. [29].”
Han, H., Hou, Y., Yao, S., Hu, S., Zhou, Q., Yu, X., McIntyre, R. S., & Shi, C. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.763603 · Cited by 10 · see citing works
Self-citationCognitive Dysfunction in Major Depressive Disorder: Cause and Effect
Knight, M. J., Aboustate, N., & Baune, B. T. (2018) · Current Behavioral Neuroscience Reports · doi:10.1007/s40473-018-0160-y · Cited by 8 · see citing works
Self-citationA critical overview of tools for assessing cognition in bipolar disorder
Rossetti, M. G., Girelli, F., Perlini, C., Brambilla, P., & Bellani, M. (2022) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796022000555 · Cited by 7 · see citing works
Clinical Quest for Associated Cognitive Impairment in Major Depressed Patients
Suciu, B. D., & Micluția, I. (2020) · Psychiatric Quarterly · doi:10.1007/s11126-020-09733-6 · Cited by 8 · see citing works
Assessment of cognitive performances in major depressed patients: a 6-month follow-up study
Suciu, B. D., Paunescu, R., & Micluția, I. (2020) · International Journal of Psychiatry in Clinical Practice · doi:10.1080/13651501.2020.1840595 · Cited by 6 · see citing works
“During the last decade, cognition has become of large interest because of a question that has been disputed: is there clear evidence of cognitive deficits in both acute and remitted major depressed patients (McIntyre et al. 2017).”
BackgroundMcIntyre, R. S., Lipsitz, O., Rodrigues, N. B., Subramaniapillai, M., Nasri, F., Lee, Y., Fehnert, B., King, J., Chrones, L., Kratiuk, K., et al. (2022) · JMIR Mental Health · doi:10.2196/33871 · Cited by 7 · see citing works
“Many commonly used comprehensive neurocognitive tests are effective MBC assessment tools, but they are lengthy and cumbersome to administer and complete and often require professional interpretation, limiting their implementation outside of a clinical environment [13,14].”
MethodSelf-citationZhu, N., Tong, J., Pei, Y., Zhang, J., & Sun, X. (2023) · BMC Psychiatry · doi:10.1186/s12888-023-04857-y · Cited by 8 · see citing works
Clark, S. R., Schubert, K. O., Olagunju, A. T., Lyrtzis, E., & Baune, B. T. (2018) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2018.00662 · Cited by 6 · see citing works
“It has been validated for use in major depression (72).”
BackgroundSelf-citationHamada, F., Hori, H., Iida, H., Yokoyama, H., Sugawara, H., Hatanaka, A., Gotoh, L., Ogata, M., Kumagai, H., Yano, R., et al. (2023) · Metabolites · doi:10.3390/metabo13090981 · Cited by 16 · see citing works
“THINC-it ® [55] is a newly developed digital screening instrument for cognitive dysfunction in patients with MDD.”
Neuropsychological instruments for bipolar disorders: A systematic review on psychometric properties
Rossetti, M. G., Girelli, F., Perlini, C., Brambilla, P., & Bellani, M. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.06.026 · Cited by 7 · see citing works
Gubics, F., Nagy, Á., Dombi, J. D., Pálfi, A., Szabó, Z., Viharos, Z. J., Hoang, A. T., Bilicki, V., & Szendi, I. (2025) · Diagnostics · doi:10.3390/diagnostics15040454 · Cited by 6 · see citing works
“…Anoma-lous Self-experiences (EASE) [45], Temperament and Character Inventory (TCI-R) [46], Morningness Eveningness Questionnaire (MEQ-SA) [47], The Behavioral Inhibition and Activation System Scales (BIS/BAS scale) [48], Leuven Affect and Pleasure Scale (LAPS) [49], Raven test [50], and THINC [51].”
Zhu, N., Zhang, W., Huang, J., et al. (2023) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s401095 · Cited by 6 · see citing works
“Data for the questionnaire items were transformed using an integrated z-score according to a method described by Mclntyre.19 https://doi.org/10.2147/NDT.S401095 DovePress Neuropsychiatric Disease and Treatment 2023:19 446 Powered by TCPDF (www.tcpdf.org) Cronbach’s α coefficient was used to calculate the internal cons…”
MethodResultInfluentialMackin, R. S., Jin, C., Burns, E. M., Kassel, M. T., Rhodes, E., Nosheny, R. L., Ashford, M. T., Banh, T., Eichenbaum, J., Knight, K., et al. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.12.045 · Cited by 5 · see citing works
“…in the clinic have shown association of MDD and cognitive dysfunction in the domains of memory, attention, information processing speed, and executive functioning (Hammar et al., 2003; Rock et al., 2014; Weiland-Fiedler et al., 2004; McIntyre et al., 2017; Davis et al., 2017; Chen et al., 2018).”
Petersen, J. Z., Bruun, C. F., Christiansen, S. H., Krogh, H. B., Kuchinke, O. V., Bernsen, C. L., Jespersen, A. E., Bardram, J. E., Kessing, L. V., & Miskowiak, K. W. (2024) · Nordic Journal of Psychiatry · doi:10.1080/08039488.2024.2434601 · Cited by 5 · see citing works
“In keeping with this, key advantages of ICAT, as compared to existing web-based screening tools, e.g. CANTAB and THINC-it [21–23], are its short administration time and the integration of advanced ASR-based algorithms to assess the domain of verbal learning and memory.”
Hori, H., & Yamato, K. (2019) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s217098 · Cited by 6 · see citing works
Park, C., Zuckerman, H., Subramaniapillai, M., Mansur, R. B., Rosenblat, J. D., Cao, B., Iacobucci, M., Lee, Y. L., Levitan, R. D., Blumberger, D. M., et al. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.112767 · Cited by 5 · see citing works
Self-citationHarrison, J., & Hendrix, S. B. (2019) · Handbook of behavioral neuroscience · doi:10.1016/b978-0-12-803161-2.00021-7 · Cited by 5 · see citing works
Self-citationYang, D., Zhan, X., Fan, Y., Gao, Y., Ma, Q., Ma, X., & Jia, M. (2025) · BMC Psychiatry · doi:10.1186/s12888-025-07277-2 · Cited by 6 · see citing works
“Previous studies have demonstrated good test-retest reliability and moderate-to-strong correlations with standard neuropsychological tests [18].”
Measurement-Based Care in Youth: An Opportunity for Better Clinical Outcomes?
Frontini, R., da Costa, C. S., Baptista, S., Garcia, C. D. C., & Vian-Lains, A. (2024) · Healthcare · doi:10.3390/healthcare12090910 · Cited by 4 · see citing works
“To complete the protocol, a screening of cognitive dysfunction is performed through a tablet utilizing the program THINC-IT [29,30].”
MethodDeMayo, M. M., Cole, J., Sohn, M. N., Bray, S., Harris, A. D., Patten, S. B., & McGirr, A. (2024) · The Canadian Journal of Psychiatry · doi:10.1177/07067437241293984 · Cited by 5 · see citing works
“Participants completed the THINC-it, a computerized cognitive battery developed as a cognitive screening tool focused on domains impacted in MDD. 14 The THINC-it has been validated against established cognitive tests, 15 demonstrated to be sensitive to the cognitive de fi cits seen in MDD, 14 and to…”
InfluentialJiang, P., Gao, Y., Wang, L., Shao, X., Zhang, L., Zhu, G., & Duan, L. (2025) · Brain and Behavior · doi:10.1002/brb3.70265 · Cited by 4 · see citing works
Kesavan, M., Rathi, L., Sinha, N., Reddy, P. V., & Bhaskar, M. (2025) · Indian Journal of Psychiatry · doi:10.4103/indianjpsychiatry.indianjpsychiatry_696_24 · Cited by 4 · see citing works
“2017) [39] web-based, patient-administered cognitive screening tool Uses gamified cognitive tasks to engage patients in completing the tests.”
Becker-Sadzio, J., Brendel, B., Weller, S., Bornheimer, E., Mehlig, U., Padberg, F., Vogelmann, U., Kammer, T., Strube, W., Martus, P., et al. (2025) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-025-01975-4 · Cited by 5 · see citing works
Wang, Q., Wen, M., Fan, S., Liu, J., Wang, X., Guo, W., Hu, J., Zhang, J., Li, B., Zhang, L., et al. (2024) · Psychology Research and Behavior Management · doi:10.2147/prbm.s448904 · Cited by 4 · see citing works
“22 Few studies have conducted comprehensive reviews of adolescents’ cognitive function in a brief time.”
BackgroundMethodInfluentialMorita, K., Miura, K., Toyomaki, A., Makinodan, M., Ohi, K., Hashimoto, N., Yasuda, Y., Mitsudo, T., Higuchi, F., Numata, S., et al. (2024) · JMIR Mental Health · doi:10.2196/56668 · Cited by 4 · see citing works
“The reliability and stability of the THINC-it have been validated [33,34]; it has also been used in patients with schizophrenia in previous studies [35].”
Method
- Authors
- McIntyre, R. S., Best, M. W., Bowie, C. R., Carmona, N. E., Cha, D. S., Lee, Y., Subramaniapillai, M., Mansur, R. B., Barry, H., Baune, B. T., Culpepper, L., Fossati, P., Greer, T. L., Harmer, C., Klag, E., Lam, R. W., Wittchen, H.-U., & Harrison, J.
- Affiliations
- University Health Network (CA)
- Queen's University (CA)
- Centre for Addiction and Mental Health (CA)
- The University of Adelaide (AU)
- Boston University (US)
- Centre National de la Recherche Scientifique (FR)
- The University of Texas Southwestern Medical Center (US)
- Warneford Hospital (GB)
- University of British Columbia (CA)
- King's College London (GB)
- ORCID
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2017-08-23
- Volume
- 78
- Issue
- 7
- Pages
- 873-881
- ISSN
- 0160-6689 (ISSN-L)
- OpenAlex
- W2747517649
- Cited by
- 172
- References
- 0
- Citations by year
- 2026: 21 · 2025: 20 · 2024: 17 · 2023: 22 · 2022: 26 · 2021: 16 · 2020: 15 · 2019: 16 · 2018: 15 · 2017: 4
- FWCI
- 9.54
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Historical and Modern Theater Studies
- Keywords
- cognitive impairment, major depressive disorder, screening tool, computerized cognitive assessment, concurrent validity, Trail Making Test, Digit Symbol Substitution Test, functional disability
- MeSH terms
- Adolescent, Adult, Aged, Cognition Disorders, Major Depressive Disorder, Diagnosis, Computer-Assisted, Female, Humans, Male, Mass Screening, Middle Aged, Neuropsychological Tests, Psychometrics, Recurrence, Reference Values, Reproducibility of Results, Young Adult
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